Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Wednesday, December 27, 2006

Back, and consumer friendly

Sorry for the hiatus -- which was a bit longer than I expected. I had to deal with some family issues, which happen to be relevant to Stayin' Alive, so I expect I'll get to that shortly. For now, though, a reader asked me to comment on an ad campaign that Coca Cola is apparently running boasting that they have donated to the fight against obesity.

I haven't seen the ads, but I'll stipulate that they exist. My response to this is that it's the equivalent of George W. Bush holding a press conference to announce that he is donating to Iraq Veterans Against the War. Coke is not even the sugariest soda out there, but a 12-ounce can contains 27 grams -- almost a full ounce -- of simple sugar. That's 240 calories, or about 10% of all of the calories that a typical active adult should consume in an entire day. Supersize it, and you have the caloric equivalent of a full meal. (By the way, the label on a 12 ounce bottle of Coca Cola claims that a serving consists of 5 ounces, and contains only 100 calories. That is what we in the sociolinguistics biz call a lie.)

Of course, it's not a meal, it's just calories. No protein. No vitamins or micronutrients. No dietary fibre. So either it displaces actual food, and leaves you malnourished; or it adds calories, and makes you fat. And we're talking a lot of real food that you can't eat, or a lot of fatter that you become.

And that's not all. This next part is extremely important. I'm sure most of my readers already know it but if you aren't clear on it, pay attention, because if you don't smoke, this is the most important thing you need to know about your own health. Why is there such a terrible epidemic of diabetes in the United States? It's partly because people are overweight, but that's actually not the main reason.

When we consume carbohydrates, they are converted to glucose, the sugar that circulates in the blood, at differing rates depending on the kind of carbohydrate, and what else we eat at the same time. A sharp increase in blood sugar is called a glycemic spike. When we experience a glycemic spike, the pancreas responds by pumping out extra insulin, a hormone the cells use to take in glucose, thereby reducing the level in the blood. Over time, if we experience frequent, excessive glycemic spikes, the cells lose their ability to respond to insulin, and the pancreas has to pump out more and more of it. Eventually the body loses the ability to regulate the level of blood sugar. That's Type 2 diabetes, which causes terrible damage to the body and then kills you in very unpleasant ways.

The glycemic index measures the contribution of a particular carbohydrate-rich food to causing a glycemic spike. The sugar in Coca Cola and other sodas is actually not the worst kind of carbohydrate you can eat -- that distinction belongs to the simple starch in some kinds of potatoes and refined flour -- but it's pretty bad. The glycemic index of Coke is about 65, which is right up there. It's higher than some potatoes and lower than others, and comparable to white breads. Fruit juices, such as orange and grapefruit juice, in contrast, have much lower glycemic indices, in the 40s. Vegetables, even fairly sugary ones such as carrots (which once had an undeserved bad rep) also have indices in the 40s and low 50s. Furthermore, starchy foods such as bread and baked potatoes are usually eaten with protein and dietary fiber, in sandwiches or complete meals, which slows absorption of the sugar and so reduces the glycemic spike. For this reason, by the way, candy bars, which typically contain proteinaceous ingredients such as nuts and milk, actually have fairly low glyemic spikes. In other words, you're much better off eating a Snickers bar than you are drinking a Coke.

Glycemic spiking is associated not only with diabetes, but with atherosclerosis, heart disease, and strokes. The only time it makes sense to drink soda or so-called "energy drinks" is if you've just been engaging in intensive exercise and your blood sugar is low. Otherwise, that stuff is poison. Quite literally. It contributes nothing nutritionally, and it does a lot of harm. It is sold in food stores, as food, and it's labeled like food. But it isn't food. Don't consume it.